Relative Effects of Minoxidil 5%, Platelet-Rich Plasma, and Microneedling in Pattern Hair Loss: A Systematic Review and Network Meta-Analysis

Abstract

<b><i>Background:</i></b> Combination treatments may improve the utility of approved agents for the treatment of pattern hair loss (PHL); however, head-to-head comparisons are lacking. <b><i>Objective:</i></b> The aim of the study was to compare the efficacy of 5% minoxidil, platelet-rich plasma (PRP), and microneedling across adults with PHL insofar as change in total hair density at 24 weeks. <b><i>Methods:</i></b> We conducted a literature search in July 2022. Through our Bayesian network meta-analysis, we estimated treatments’ surface under the cumulative ranking distribution (SUCRA) values and relative effects – in terms of mean difference (MD). <b><i>Results:</i></b> Data from 27 trials, totaling 1,110 patients, were extracted. Interventions were ranked based on the probability of inducing hair density improvements: 5% minoxidil plus microneedling (SUCRA = 95.8%), 5% minoxidil plus PRP (SUCRA = 64.7%), 5% minoxidil (SUCRA = 53.9%), PRP (SUCRA = 34.9%), microneedling (SUCRA = 27.8%), and PRP with microneedling (SUCRA = 22.9%). The efficacy of 5% minoxidil plus microneedling in improving total hair density was significantly greater (<i>p</i> < 0.05) than 5% minoxidil monotherapy (MD = 13 hairs/cm<sup>2</sup>), PRP monotherapy (MD = 16 hairs/cm<sup>2</sup>), and microneedling monotherapy (MD = 17 hairs/cm<sup>2</sup>). <b><i>Conclusion:</i></b> Five percent minoxidil plus microneedling is an effective treatment option for improving hair density at 6 months in adult PHL patients.